MEDICARE: MRS. MARGARET M DOMBROWSKI DTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	136A00000X	Registered Dietetic Technician	835191	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	835191	OTHER	NY	DIETETIC ASSOCIATION

General Provider Information

NPI Number	:	1962658823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARET M DOMBROWSKI DTR

Provider Business Mailing Address
First Line	:	4228 MASSERIA CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3663
Country	:	US
Telephone Number	:	702-982-6233
Fax Number	:

Provider Business Practice Location Address
First Line	:	5693 S JONES BLVD STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1967
Country	:	US
Telephone Number	:	702-889-9240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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